The Prevention of Iodine Deficiency: A History.

Iodine is an essential component of the hormones produced by the thyroid gland and is, therefore, essential for mammalian life. A landmark trial in the early 20th century definitively demonstrated that iodine supplementation could prevent what was then known as "endemic goiter." Subsequent studies over the next decades demonstrated that iodine deficiency causes a spectrum of disease, including not just goiter, but also cretinism, intellectual impairment, and adverse obstetric outcomes. Salt iodization, first used in Switzerland and the United States in the1920s, has become the mainstay of iodine deficiency prevention efforts. The dramatic reduction in the global prevalence of iodine deficiency disorders (IDD) over the past 30 years represents an outstanding and under-recognized public health achievement. This narrative review provides an overview of critical scientific discoveries and advances in public health nutrition related to the prevention of IDD in the United States and worldwide. This review was written to commemorate the centennial of the founding of the American Thyroid Association.

Thyroid function tests of iodine deficiency goiter can mimic thyroid hormone resistance alpha.

OBJECTIVES: Iodine deficiency goiter can develop in children on a restrictive diet and most have normal thyroid function. We report a 6-year-old girl with iodine deficiency goiter with thyroid function studies mimicking thyroid hormone resistance alpha. Thyroid hormones mediate its effects through thyroid hormone receptors alpha and beta. Biochemical picture of low/low-normal T4 and high/high-normal T3 levels, variably reduced reverse T3 and normal TSH is characteristic of thyroid hormone resistance alpha. CASE PRESENTATION: A 6-year-old girl, born out of non-consanguineous marriage presented with goiter of 1.5 years duration. She was without symptoms of thyroid dysfunction. The patient was evaluated at one year of age for macrocephaly with cranial ultrasound which was normal. She had normal growth and development. Patient was vegan and was not on any medications or supplements. Laboratory work up showed TSH 5.03 uIU/mL (0.34-5.5), FT4 0.3 ng/dL (0.58-1.2), FT3 5.3 pg/mL (2.5-3.9), total T3 258 ng/dL (94-241), reverse T3 <5.0 ng/dL (8.3-22.9) and negative thyroglobulin antibody and thyroid peroxidase antibody. Thyroglobulin level was 1,098.8 ng/mL (<13 ug/L), and urine iodine 15.8 ug/L (<100 ug/L) confirming a diagnosis of iodine deficiency goiter. Patient was started on iodine supplements, 150 ug daily and repeat work up 3 months later were TSH: 2.717 uIU/mL, T3, total 182 ng/dL, T4, total 9.3 ug/dL, FT 4 2.1 ng/dL. CONCLUSIONS: Iodine deficiency goiter may present with low FT 4, elevated T3 and normal TSH mimicking thyroid hormone resistance alpha and should be considered in children on restrictive diet.

Familial Aggregation of Endemic Congenital Hypothyroidism Syndrome in Congo (DR): Historical Data.

Familial aggregation of endemic congenital hypothyroidism (CH) in an iodine-deficient population from northern Congo (Democratic Republic (DR)) was analysed on data collected four decades ago (1979-1980). During a systematic survey of 62 families, 46 endemic CH subjects (44 myxedematous and 2 neurological) were identified based on clinical evidence within a village cohort of 468 subjects. A distribution analysis showed that two families presented significant excess of cases versus a random background distribution. Both families were characterised by two healthy parents having all of their five offspring affected by some form of endemic CH. Goitre prevalence in endemic CH was lower than that in the general population, while goitre prevalence in the unaffected part of the cohort (parents and siblings) was similar to that of the general population. Some unidentified genetic/epigenetic factor(s) could contribute to the evolution of some iodine-deficient hypothyroid neonates through irreversible and progressive loss of thyroid functional capacity during early childhood (<5 years old). Besides severe iodine deficiency, environmental exposure to thiocyanate overload and selenium deficiency, factors not randomly distributed within families and population, intervened in the full expression of endemic CH. Further exploration in the field will remain open, as iodine deficiency in Congo (DR) was eliminated in the 1990s.

Goiter in Brazilian modernism paintings / Bócio em pinturas da arte moderna brasileira

Objective: To evaluate Di Cavalcanti's artworks in which goiters are represented before and after the introduction of iodized salt to the Brazilian population. Methods: One hundred and thirty paintings by Di Cavalcanti from the 20's to 70's demonstrating necks were evaluated. All the paintings were observed in reproductions. The neck circumference in the paintings was measured. Since there were no standard thresholds of neck circumference, cutoffs were based on the median. Baseline characteristics of artworks were compared based on high and normal neck circumference categories using Student's t-test, Mann-Whitney-Wilcoxon test, or chi square test. Results: We analyzed 29 artworks which portray the neck of 60 women (84.5%), 8 men (11.3%) and 3 children (4.2%). The analyses of the neck circumference showed 23.3% of women (14/60), 12.5% of men (1/8), and 33.3% of children (1/3) with an abnormal profile of the neck circumference. The neck circumference ratio in 29 paintings showed that the relative sizes of the necks painted between the 1920's and 1950's (r=0.45; p=0.03), and painted between the 1960's and 70's (r= 0.54; p=0.003) have linearly decreased. The decades in which the artworks were painted explained 40.0% of the variation in size of the neck circumference (p=0.002). Conclusion: Art imitates life. Di Cavalcanti was not a physician, and probably did not have the intention to illustrate a pathological condition, although the images observed in this study should be considered as goiter or enlarged neck.

Objetivo: Avaliar as obras de Di Cavalcanti em que bócios estão representados, antes e após a introdução da iodação do sal para a população brasileira. Método: Foram avaliadas 130 pinturas de Di Cavalcanti entre os anos 1920 e 1970 demonstrando pescoços. Todas as pinturas foram observadas em reproduções. A circunferência do pescoço nas pinturas foi mensurada. Como não existia limite-padrão da circunferência do pescoço, os limites foram baseados na mediana. As características básicas das obras de arte foram comparadas por categorias da circunferência do pescoço em elevadas e normais, usando o teste t de Student, o teste de Mann-Whitney-Wilcoxon ou o teste qui-quadrado. Resultados: Analisamos 29 obras de arte que representavam o pescoço de 60 mulheres (84,5%), 8 homens (11,3%) e 3 crianças (4,2%). Ao analisar a circunferência do pescoço, 23,3% das mulheres (14/60), 12,5% dos homens (1/8) e 33,3% das crianças (1/3) demonstraram perfil anormal dela. A relação da circunferência do pescoço em 29 pinturas demonstrou que as circunferências do pescoço relativas aos pescoços pintados entre os anos 1920 e 1950 (r=0,45; p=0,03) e pintados entre os anos 1960 e 1970 (r=0,54; p=0,003) reduziram linearmente. As décadas em que as obra foram pintadas explicaram 40,0% da variação no tamanho da circunferência do pescoço (p=0,002). Conclusão: A arte imita a vida. Di Cavalcanti não era médico e, provavelmente, não tinha intenção de ilustrar uma condição patológica, embora as observações das imagens, neste estudo, tenham sido consideradas como bócio ou com aumento de volume do pescoço

Iodine deficiency and nutrition in Scandinavia.

Iodine nutrition is a result of geological conditions, iodine fortification and monitoring strategies within a country together with the dietary habits of the population. This review summarizes the basis for the current iodine situation in the Scandinavian countries in order to identify gaps in knowledge, determine necessary future steps, highlight landmarks in Scandinavian iodine research and consider ongoing studies in Scandinavian countries with high international impact. Historically, iodine deficiency disorders such as goiter were common in Norway and Sweden, but not in Denmark. Different strategies have been used in Scandinavia to improve iodine nutrition. The major source of iodine is iodized salt in Sweden and from milk and dairy products in Norway. In Denmark, drinking water, milk, dairy products and iodized salt used in commercial production of bread are the important sources of iodine. The current iodine status in Scandinavia is not optimal and action is ongoing to increase iodination in Denmark, where there is mild iodine deficiency in the general population. Data from all three countries indicate insufficient iodine nutrition during pregnancy and there is a need for data from children, adolescents and young women. Monitoring a population's iodine status and dietary iodine sources is necessary to secure iodine nutrition in Scandinavia. Ongoing studies in Scandinavia will contribute significantly to the knowledge about the effects of mild to moderate iodine deficiency.

Iodisation of Salt in Slovenia: Increased Availability of Non-Iodised Salt in the Food Supply.

Salt iodisation is considered a key public health measure for assuring adequate iodine intake in iodine-deficient countries. In Slovenia, the iodisation of all salt was made mandatory in 1953. A considerable regulatory change came in 2003 with the mandatory iodisation of rock and evaporated salt only. In addition, joining the European Union's free single market in 2004 enabled the import of non-iodised salt. The objective of this study was to investigate the extent of salt iodising in the food supply. We examined both the availability and sale of (non-)iodised salt. Average sales-weighted iodine levels in salt were calculated using the results of a national monitoring of salt quality. Data on the availability and sales of salts were collected in major food retailers in 2014. Iodised salt represented 59.2% of the salt samples, and 95.9% of salt sales, with an average (sales-weighted) level of 24.2 mg KI/kg of salt. The average sales-weighted KI level in non-iodised salts was 3.5 mg KI/kg. We may conclude that the sales-weighted average iodine levels in iodised salt are in line with the regulatory requirements. However, the regulatory changes and the EU single market have considerably affected the availability of non-iodised salt. While sales of non-iodised salt are still low, non-iodised salt represented 33.7% of the salts in our sample. This indicates the existence of a niche market which could pose a risk of inadequate iodine intake in those who deliberately decide to consume non-iodised salt only. Policymakers need to provide efficient salt iodisation intervention to assure sufficient iodine supply in the future. The reported sales-weighting approach enables cost-efficient monitoring of the iodisation of salt in the food supply.

Evaluación del estado de nutrición yódica en población general en la provincia de Jaén / Assessment of iodine nutritional status in the general population in the province of Jaén

ANTECEDENTES Y OBJETIVO: En Jaén se conoce que existe una deficiencia de yodo (DY) de leve a moderada, y que afecta tanto a escolares como a mujeres embarazadas. Se sabe que la DY es una de las causas principales de disfunción tiroidea y bocio, habiéndose establecido que una yodoprofilaxis adecuada en zonas yododeficientes, tanto en forma de sal yodada, leche y sus derivados, o la toma de suplementos yodados, en caso de gestación, conlleva una mejoría significativa de estos problemas. El objetivo de este estudio es evaluar el grado de nutrición yódica en población general en una zona catalogada como yododeficiente y sin que se hayan llevado a cabo, por el momento, campañas institucionales de yodoprofilaxis. MATERIAL Y MÉTODOS: Estudio descriptivo de corte transversal. Se ha realizado determinación de la yoduria en población general en el distrito sanitario de Jaén, separando en grupos según la edad y el género, y se ha encuestado sobre del consumo de sal yodada. RESULTADOS: La mediana de yoduria fue de 110,59 μg/l y la media de 130,11 μg/l. Se encuentran diferencias estadísticamente significativas en los niveles de yoduria en los escolares con respecto al resto de grupos de edad, siendo la media de yoduria en este grupo de 161,52 μg/l vs 109,33 μg/l en los mayores de 65 años. Encontramos que el 43% de la población tiene una yoduria menor de 100 μg/l y que en las mujeres, en el grupo de edad fértil, hay un 66,8% con niveles de yoduria inferior a 150 μg/l. CONCLUSIONES: la situación nutricional de yodo indicaría que se encuentra dentro de lo que se considera una nutrición adecuada, si bien encontramos que el porcentaje de población que presenta yodurias por debajo de 100 μg/l es aún muy elevado, y que la prevalencia del consumo de sal yodada en hogares es del 30,9%, muy por debajo de las recomendaciones de la OMS

BACKGROUND AND OBJECTIVE: Iodine deficiency affecting both pregnant women and schoolchildren has been reported in Jaén. Iodine deficiency is one of the leading causes of thyroid dysfunction and goiter, and adequate iodine prophylaxis with iodized salt, milk, and dairy products, or iodine supplementation have been shown to significantly improve iodine status in pregnancy. The purpose of this study was to assess iodine nutritional status in the general population of a iodine-deficient area with no previous institutional campaigns of iodine prophylaxis. MATERIAL AND METHODS: A descriptive, cross-sectional study. Urinary iodine levels were measured in subjects from the Jaén healthcare district. The data were stratified by sex and age groups, and a survey was conducted on iodized salt consumption. RESULTS: Median and mean urinary iodine levels were 110.59 mcg/L and 130.11 mcg/L respectively. Urinary iodine levels were significantly higher in schoolchildren as compared to other age groups (161.52 μg/L vs 109.33 μg/L in subjects older than 65 years). Forty-three percent of the population had urinary iodine levels less than 100 μg/L, and 68% of women of childbearing age had levels less than 150 μg/L. CONCLUSIONS: Iodine nutritional status appears to be adequate, but the proportion of the population with urinary iodine levels less than 100 μg/L is still very high, and iodized salt consumption is much less common than recommended by the WHO

Effect of maternal iodine supplementation on thyroid function and birth outcome in goiter endemic areas.

OBJECTIVE: The study was undertaken to examine the clinical and endocrine parameters of thyroid in a total of 460 pregnant women belonging to non-goiter areas (group 1; n = 156) and endemic areas without (group 2; n = 154) and with iodine supplementation (group 3; n = 150), and their respective newborns. METHODS: Women of group 3 with visible goiter were administered two capsules of iodized oil orally each containing 200 mg of iodine, from weeks 6--8 of pregnancy. Blood samples were obtained from all groups during each trimester, at parturition (umbilical cord blood) and after delivery. Serum triiodothyronine (T3), thyroxine (T4) and thyroid stimulating hormone (TSH) levels were measured by specific enzyme immunoassays. RESULTS: In group 2, serum T4 concentrations were low while T3 and TSH levels were high which showed hypothyroidism in the women of endemic areas. Goiter size decreased in most of the subjects who received a single dose of iodized oil and resulted in increase in serum concentrations of thyroid hormones; whereas, TSH levels decreased. Iodine supplementation also resulted in raised T4 and low TSH levels in the cord blood of neonates. During the course of study, two abortions, three still births and one cretin were reported in group 2; none was reported in group 3; and one still birth was reported in group 1. CONCLUSIONS: The oral administration of a single dose of iodized oil is capable of correcting iodine deficiency both clinically and endocrinologically in mothers and neonates. Iodine supplementation has the potential to positively impact the birth weight of newborns.

[Effectiveness of the program "School Milk" for the prevention of iodine deficiency].

Republic of Bashkortostan refers to iodine-deficient regions of Russia. The incidence of endemic multinodular goiter in 2012 in the Republic amounted to 33.2 per 100 thousand of the population. The purpose of the study is to evaluate the effectiveness of group iodine prophylaxis of schoolchildren through the use of iodized milk. The study included 181 children of primary school (pre-pubertal) age (8-10 years), it has been carried out in accordance with the recommendations of the WHO and the International Council for Control of iodine deficiency disorders using a unified system of identification of iodine deficiency states. Level of physical development was assessed according to anthropometric measurements, which were conducted by centile distribution tables according to age and sex, and the individual assessment of physical development was determined by the level of feature by its position in a number of centile. Assessment of iodine deficiency was carried out by determining levels of iodine excretion in a single urine sample. Iodine concentration in urine was determined by ceric ion-arsenious acid method. Frequency of iodine deficiency varying degrees before the iodine prophylaxis among urban children was 57.0%, among rural-92.3%. Urban junior schoolchildren showed severe iodine deficiency in 12.7% and moderate one in 16.4% of the cases, while in the countryside their prevalence was higher--27.4 and 35.2%, respectively. It was revealed that the number of children whose body growth values are within the average values is 36% in urban children, and 48.4% in rural areas. It should be noted that the low and very low body height predominate in rural students, it makes up 16.1% (while in the town it makes-up 2.3%). Iodine prophylaxis contributed to a significant reduction of iodine deficiency in children. In the town the median urinary iodine exceeded 100 mg/L and amounted to 159.4 mg/L. After iodine prophylaxis 82.5% of urban children and 72.1% of rural showed normal urinary iodine. When comparing the results of clinical and laboratory studies before and after the group prevention of iodine deficiency there has been revealed a positive trend in terms of reflecting the tensions of thyroid status.

[Imbalance of microelements and vitamins in adolescents with diffuse nontoxic goiter and biliary dyskinesia].

The purpose of the present work was to study the level of microelements and vitamins in adolescents with diffuse nontoxic goiter. It has been shown that comorbid biliary dyskinesia leads to significant dysregulation of vitamin and mineral metabolism: the level of essential elements was decreased and the level of toxic elements was increased. Comorbid biliary dyskinesia in adolescents with diffuse nontoxic goiter was accompanied by a disbalance of vitamins. The changes found in micronutrients have sex differences.

[Experience of using phytopreparation Alba (root extract of the Potentilla alba) in complex treatment of thyroid pathology in children and adolescents].

This article presents the background for including phytopreparation Alba (root extract of the Potentilla alba) into complex treatment of thyroid pathology. The findings confirm visible reduction of size of the thyroid gland and normalizing its functions in children and adults with the thyroid gland with normal or enhanced function treated by Alba per oral.

Pathology and the surgical management of goitre in an endemic area initiating supplementary iodine nutrition.

UNLABELLED: Goitre in the West African sub-region is caused by iodine deficiency and goitrogens in the diet. Supplementary iodine nutrition on a mass scale was started in Ghana in 1996. In areas where iodine deficiency have been corrected the histological pattern of goitre changes and this influences surgical decision making. Data on the histological types of goitre in our institution is lacking. OBJECTIVE: To define the histopathological types of goitre in this initial period of iodine supplementation and relate this to the types of thyroid surgeries that were performed. METHODS: It was a prospective study of consecutive patients who underwent thyroidectomy from January 2003-December 2007. Descriptive statistics was employed in analyzing the data RESULTS: Five hundred and twenty eight cases were studied made up of 470 (89%) females and 58 (11%) males with mean age of 41.98 yrs, SD ± 12.90 yrs. The excised mean thyroid tissue weight was 161.4 g, SD ± 116.3 yrs. Hyperplastic goitres were 373 (70.7%), toxic goitre 70 (13.3%), adenoma 37 (7.0%), carcinoma 25 (4.7%) and thyroiditis 23 (4.4%). Papillary carcinoma accounted for 56% (14) cancers. Subtotal thyroidectomy was performed in 278 (52.7%) of patients, near total thyroidectomy 107 (20.3%), lobectomy 98 (18.6%),total thyroidectomy 24 (4.5%), excision or completion thyroidectomy 20 (3.8%) and de-bulking 1 patient. Overall, complications occurred in 32 patients (6.1%) and were made up mostly of haemorrhage in 10 (1.9%), Hypocalcaemia 10 (1.9%), unilateral Recurrent Laryngeal Nerve(RLN) injury 3 (0.57%), Tracheal collapse 3 (0.57%) and Bilateral RLN injury 2 (0.4%). CONCLUSION: The introduction of iodine supplementation on a mass scale in Ghana is yet to have its fullest impact on thyroid diseases. Goitres are still large and cause pressure effects. Toxic, inflammatory and malignant goitres are gaining prominence, and surgery for malignant goitre was oncologically inadequate.Near total thyroidectomy is recommended as the minimum surgery to avert the need for completion thyroidectomies in view of the lack of preoperative pathological diagnosis of thyroid lesions.

Economic evaluation of iodine deficiency disorder control program in Sikkim: a cost-benefit analysis.

BACKGROUND: Iodine deficiency disorders (IDDs) are the most common cause of preventable brain damage globally. The strategy of prevention and control of iodine deficiency is based on iodine supplementation. Edible salt iodization and iodized oil injections are the two most commonly used vehicles for iodine supplementation. The objective of the study was to conduct a cost-benefit analysis of the two programs of iodine supplementation, i.e., iodized salt program (ISP) and iodized oil program (IOP) against no preventive program (NPP) option. MATERIALS AND METHODS: The study was conducted in 1990 in the state of Sikkim in India. The costs were calculated on the assumption of universal coverage of ISP and coverage of IOP among all children aged 0-14 years and women in the age group of 15-44 years. Direct and indirect cost of ISP and direct cost of IOP was computed based on the costs of year 1991. The discount rate taken was 10% and all the costs were converted to the year 2010 using wholesale price index (WPI) data. Consequences in terms of health effects, Social/emotional effects, and resource use were included. RESULTS: The discounted cost of ISP and IOP was Rs. 59,225,964 and Rs. 46,145,491, respectively. In ISP, 64.1% of the total cost was required for salt iodization, 17.6% for monitoring, and 18.3% for communication. In IOP, 50.9% of the costs were required for iodized oil; rest was for syringes and needles, manpower expenses, travel, and communication. Total resource saving was Rs. 95,566,220 for ISP and Rs. 92,177,548 for IOP. Incremental benefit for ISP was Rs. 36,340,256 and Rs. 46,032,057 for IOP. The cost-benefit ratio for ISP was 1.61 and 2.00 for IOP. CONCLUSION: IOP has a higher cost-benefit ratio for prevention of IDDs than ISP in the state of Sikkim, India.

Evolucion del estado de nutricion de yodo en los escolares de la Comunidad Autonoma del Pais Vasco / Changes in iodine nutrition status in schoolchildren from the Basque Country

Introduccion Un estudio epidemiologico demostro en 1992 la existencia de deficiencia de yodo y bocio endemico en los escolares de la Comunidad Autonoma del Pais Vasco (CAPV).Objetivos1) Conocer el porcentaje de las viviendas de escolares en las que se consume sal yodada (SY); 2) estudiar el estado de nutricion del yodo en la poblacion escolar y comparar los datos obtenidos con los disponibles de estudios epidemiologicos anteriores. Metodos Estudio descriptivo transversal en 720 escolares seleccionados mediante muestreo aleatorio. Las determinaciones de concentracion urinaria de yodo (CUY) se realizaron mediante cromatografia liquida de alta resolucion (HPLC) (..) (AU)

Background: An epidemiologic survey showed in 1992 iodine deficiency and endemic goiter in schoolchildren from the Basque Country. Objectives: 1) To determine the percentage of homes of schoolchildren where iodized salt (IS)is used; 2) to assess iodine nutrition status in schoolchildren and to compare the data collected to those available from previous epidemiological studies. Design and Methods: A cross-sectional study in 720 randomly selected schoolchildren. Urinary iodine concentration (UIC) was measured using high-performance liquid chromatography(HPLC)with electrochemical detection. Results: IS was used at 53.0% of the homes (95% confidence interval [CI], 49.2-56.7%). Median UIC has increased by 226%, from 65 g/L in 1992 to 147 g/L (percentile [P], P25, 99 g/L;P75, 233 g/L) today. Both schoolchildren consuming IS and those using unfortified salt at their homes had UICs corresponding to adequate iodine intakes (165 and 132 g/L respectively). UICs experienced great seasonal fluctuations, being 55% higher during the November-February period than in June-September period (191 g/L vs 123 g/L; p < 0.001)Conclusions: Schoolchildren from the Basque Country have normalized their iodine nutrition status. The strong seasonal pattern of UICs suggests that consumption of milk and iodine-rich dairy products coming from cows feed iodized fodder is one of the most significant factors involved in the increase in iodine intake since 1992 (AU)

Economic evaluation of iodine deficiency disorder control program in Sikkim: a cost effectiveness study.

BACKGROUND: Edible salt iodization and iodized oil injections are the two most commonly used vehicles for iodine supplementation. In year 1989, the state government of Sikkim was planning to implement Iodine Deficiency Disorder control program in state and had following two options to choose from, based on existing knowledge; a) a salt iodization program, b) an iodized oil injection program. No information was available at that point of time on comparative advantages of the above stated two approaches. OBJECTIVES: To identify the most cost-effective alternative for IDD elimination in Sikkim, amongst the following 3 alternatives: a) Iodized salt program (ISP), b) Iodized oil injection program (IOP) to high risk group, c) no preventive program. MATERIALS AND METHODS: Study population was the general population of state of Sikkim, India in year 1990. Cost- effective analysis was undertaken comparing 3 alternative programs, targeted towards IDD elimination in state of Sikkim. Identification, measurement and valuation of the costs of ISP and IOP and identification and measurement of the consequences of IDD were done to carry out the cost-effective analysis. Visible goiter person years (VGPY), endemic cretinism, IDD attributable death were used to assess the health consequences/disease burden of IDD. RESULTS: The cost per VGPY, endemic cretinism and IDD attributable death were Rs 76.67, Rs 24,469 and Rs 9,720, respectively for ISP. The cost per VGPY, endemic cretinism and IDD attributable death were Rs 75.82, Rs 19,106 and Rs 7,709, respectively for IOP. CONCLUSION: The results of the analysis showed that iodized oil program is more cost-effective for prevention of irreversible IDDs than the iodated salt program in state of Sikkim, India.

Work of the Polish Council for Control of Iodine Deficiency Disorders, and the model of iodine prophylaxis in Poland.

The Polish Council for Control of Iodine Deficiency Disorders (PCCIDD) was established in 1991 in Krakow at the Chair and Dept. of Endocrinology, Jagiellonian University, Collegium Medicum, following the example of the International Council for Control of Iodine Deficiency Disorders (ICCIDD) in Charlottesville, USA. The PCCIDD co-operates with the European Co-ordinating Centre in Pisa, Italy. The PCCIDD comprises a group of experts in endocrinology, iodine prophylaxis, the technology of salt and food iodisation, and Polish representatives of several organisations: WHO, UNICEF, the Polish Consumers Federation, and the Spokesman for Children's Rights. The strategic goal of the Polish Council is to solve the problem of iodine deficiency in Poland realising the Programme for Elimination of Iodine Deficiency financed by the Ministry of Health. The Polish model of iodine prophylaxis contains obligatory iodisation of household salt (20-40 mg KI/1 kg) and neonates' formula (10 µg/100 mL of milk), and additional supplementation for pregnant and breastfeeding women with 150-200 µg of iodine as pharmacotherapy. The model is very effective: endemic goitre in schoolchildren has been eradicated, the prevalence of goitre in pregnant women has fallen from 80% to 19%, the frequency of transient hypothyroidism in neonates has dropped from 2.0% to 0.16%, and the observed increase of incidence rate of thyroid cancer in women over 40 years old has diminished markedly. In 2008, a WHO Collaborating Centre (WHOCC) for Nutrition was designated at the Department of Endocrinology, UJCM in Krakow. The main goal of the WHOCC is to sustain effective iodine prophylaxis in Poland in the light of the latest WHO recommendations on the necessary reduction of daily salt intake as a risk factor for hypertension and arteriosclerosis. Therefore, additional standardised carriers of iodine (milk, mineral water) have been introduced into the food market.

Tendencia de la nutrición de yodo durante las últimas décadas en escolares chilenos y sus consecuencias / Trend of iodine nutrition in recent decades and its consequences in Chilean schoolchildren

The endemic goiter, nutritional collective problem due to iodine deficience, constitutes a chronic disease with easy prevention and control, nevertheless still it constitutes a serious problem of public world health, being thought that about 650 million persons have goiter, 43 millions suffer from endemic cretinism and 1570 millions are in risk of suffering this disease for living in areas that present a deficit of iodine. Both patterns, deficit and the excess of iodine can conducted to a thyroid disease. The relation between the ingestion of iodine and the risk of disease corresponds to a U curve, where both, the low one and high ingestion of iodine it is associate to high risk of thyroid disease. To have a program of iodine supplementation, it should imply a constant vigilance of iodine nutrition to see its effect on the goiter prevalence in the population, to control his degree of fulfillment, to avoid a possible excess of ingestion of iodine it might help to correct any precocious alteration. Endemic goiter is not longer a problem in Chile. Salt iodination is in agreement with present legislation, but it is very important to have a continuous surveillance of iodine nutrition in Chile to control if salt fortification is appropiate.